740393.pdfBUILDING DEPARTMENT
AppHeant Fill
ONE /2s - /02 NUMBETR. 740393
PERMIT APPLICATION
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ADDRESS / {3 p !/... !�V54 41'
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I.OT COVEMOL� LOT COVF.HAGE
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PERMISSIBLE HEIGHT PROPOSED HEIGHT
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ACTUAL LOT AREA TOTAL BLDG. AREA
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REQUIRED YARDS PROP08ED YARDB
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FRONT HIDE REAR FRONT BIDE REAR
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ADDRESS
LEGAL LOT VAR ANCE OR CONDITIONAL USE
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PLANNING DEPT. APPROVAL DATE:
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CITY TELEPHONE
NUMBER
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STREET R/W
EXISTING IITREET R/W, ........DEFICIENCY T IB PROPERTY
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NAME
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REMARKS
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NUMDEft
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UMETER
SIZE SERVICE SIZE CLEARANCE
CHECKED HY
STATE LICENSE NUMBER CITY
LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
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TYPE CONNECTIONI
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PERC. TEST
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REMARKS
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TYPE OF CONSTRUCTION IITREET IMPROVED
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L O YES X NO
SPECIAL INSPEECCTOR REQUIRED OCCUPANCY GROUP
�RE8IDENTIAL
BAS
❑ LINE
[3 YES � NO
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NEW
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
1:1SH
Of EDMONDS. LOCAL SALES TAX
BION
OULD BE CODED 31.04.
El nnD ❑ RETAINING
WALL
REMARKS
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ALTER I y RCFILL E ❑ FEN.............Ft.)
�44-4,
`yPRE-MOVE
REPAIR [:] ❑ POOL
NUMBER OF STORIES NUMBER OF
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DWELLING
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UNITS
NATURE OF WORK TO BE DONEi'
Valuntlon
Fee Recclpl No.
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Plan Check No................ _...
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BUILDING
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PROPOSED USE
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RETAINING WALL
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SWIMMING POOL
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DEMOLITION
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PRE-MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
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I hereby acknowledge that I have rend this application; that the In-
tormntlon given Is m correct; and that I athe owner, or the duly authnr-
I:ed agent of the owner. t agree to comply with Illy and stele Ino toga-
ATTENTION
APPLICATION APPROVAL
lating conetructlon; and in doing the Work authorlred thereby, no Donors
Will be employed In violation of the Labor Code of the Stale of Washington
THUS PERMIT
This application is not a permit until
relating to workmen'. Compeneatloa Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIRE
WORK NOTED
uty; and fees are paid, and receipt is ac-
.hall be completed In ninety day.; MOVEDAN BUILDINGS shall be corn-
Imowledged in Space provided,
piste sl% out
SIG AT RE (OWNER OR AGENT) DATE 816NEU
INSPECTION
DIRE 'S tl2 T JJRE
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DEPARTMENT
�E:
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CITY OF
EDMONDS
DATE
GTL: Ap icaut Subject to Plan Check Fee
775-2525
Tills Permll a ark to lw done on private property ONLY.
Any construction an the public damaln (curbs, .Idewelk., dAvewar.,
FILE
morqueea, etc.) will require separate permis.lon.